News outlets are referring to a report released yesterday by The Lancet Commission on Pollution and Health. The report’s authors—an international team of nearly 50 public health scientists—spent nearly two years synthesizing data on the human health effects and economic costs of toxic substances in the air, soil, and water.

Their definition of pollution comes from the European Union:

“unwanted, often dangerous, material that is introduced into the Earth’s environment as the result of human activity, that threatens human health, and that harms ecosystems.”

The headlines whet my appetite for more of the numbers and the report delivers. For example, the committee’s analysis indicates:

An estimated 9 million deaths in 2015 can be attributed to air, water, and soil pollution. This compares to an estimated 4 million deaths from obesity, 2.3 million from alcohol, and 1.4 million on roadways.

Pollution related deaths are responsible for three times as many deaths from AIDs, TB, and malaria combined.

Pollution related deaths are responsible for nearly 15 times as many deaths as those from wars and all forms of violence.

The report, however, goes much deeper than calculations and point estimates. Laced throughout the report—explicit and implicit—is a message that governments, foundations, medical societies, and research institutions pay too little attention to the impact of pollution on health. The authors call out political actors, international development and health organizations for ignoring pollution in their agendas. The authors write:

“Although more than 70% of the diseases caused by pollution are non-communicable diseases, interventions against pollution are barely mentioned in the [World Health Organization’s] Global Action Plan for the Prevention and Control of Non-Communicable Diseases.”

The identify several factors for the neglect:

“… A persistent impediment has been the flawed conventional wisdom that pollution and disease are the unavoidable consequences of economic development, the so-called ‘environmental Kuznets hypothesis.’ This Commission vigorously challenges that claim as a flawed and obsolete notion formulated decades ago when populations and urban centres were much smaller than they are today, the nature, sources, and health effects of pollution were very different, and cleaner fuels and modern production technologies were not yet available.

The authors do not shy away from articulating a path forward to address pollution. I agree with their assessment that sustainable long-term solutions will require a fundamental economic shift. We must move away from the “resource-intensive, and inherently wasteful, linear take-make-use-dispose economic paradigm.” (It’s a mouthful but sums it up well.) We must embrace and adopt a new economic system that the authors describe as one in which:

“pollution is reduced through the creation of durable, long-lasting products, the reduction of waste by large-scale recycling, reuse, and repair, the removal of distorting subsidies, the replacement of hazardous materials with safer alternatives, and strict enforcement of pollution taxes. …[An economy that] conserves and increases resources, rather than taking and depleting them.”

6 thoughts on “Pollution: not “an unavoidable consequence” of development”

10/19/2017
With widely announced reports of casualties from world pollution being so exceedingly great; the worth of clean air, water and contaminant free soils and foods becomes further emphasized and the need underscored. This also infers that ground water, being tained by chemically laden ashes from homes and towns that have burned to the ground; homes Containing plastics, household chemicals, electronics casings. industrial solvents etc. that yet need be better prevented from contaminating; and doing so by wise planning and construction and forestry management. Further actual value can be derived from societal pursuits that do not increase or require daily polluting commuting, breathing lingering wildfire smoke, and the equally dangerous fumes from detonated weaponry being used worldwide by peoples not realizing the after effects of lingering barbarism and refusal to rather nurture mutual regard also for the planet’s life sustaining land foliage -plants, trees-and other wildlife, long preceding human presence onthe planet.

Further value can be derived from not only abandoning the long adversely ramifying death dealing sado-masochistic world ‘cults of mayhem, injury,decimation and death’ but rather seeking and actually both pursuing and accepting whatever actually leads toward greater global safety and stabiity; and especially when such more optimal outcomes can and do present evidences of sure achievement and attainment, however unprecedented.

Among such novel occurrences are those widely seen successful demonstrations during the past three decades; of difficult to access wildfires being more quickly suppressed without chemicals and costly air flights, in over two countries and three states. The modes the advanced collaborative modes introduced, saved benefitting states and countries billions in firefighting, restoration & medical expenditures, yet were largely disparaged and likely deemed coincidental. This too underscores how humankind -even when shown better provenances to pursue, are prone to disregard and devalue the implications;, preferring the more risky costly familiar pursuits.

During the early AM hours of 10/21/2017 while dreaming; twice during the same dream sequence, I saw a volcano -seemingly nearby and somewhat blue and yellow in color-. when actually enabled to I look at it for a sustained period. During that second time;he second time -the first time it was more fleeting- I saw dark clouds moving slowly and , spreading overhead too. Whenever ever in the past when a dream is suddenly interrupted twice like that -and wit brilliant colors-, I’ve learned it’s more than a dream and deserves attention of others. In fact I heard other voices also shouting in alarming tones when the volcanoes were seen..

It’s very possible we all need be readied for more than just reckless human induced consequences, as heat from growing radioactive ‘waste’ is also adversely impacting the global environs . Long accumulating protective moderating elements have also been dangerously degraded, resulting in residual intensifications. And likely also enabling deeper tropospheric penetration of solar X-rays, high energy UV and cosmic rays..

Thanks to the author Dr. Monforton for bringing attention to this critical health issue and for linking to The Lancet Commission on Pollution and Health report. I’m currently an MPH student and the topic caught my eye. The numbers are truly alarming! I particularly appreciated the attention given to framing air pollution as a public health problem that can be solved.

The goal of this response is to engage more with the ideas in the report, especially around the health disparities, human rights, and environmental justice questions the report raises. In other words, do we not have an obligation as health practitioners to promote moving towards “adopt[ing] a new economic system” and “[An economy that] conserves and increases resources, rather than taking and depleting them” as you write? And what are some policy steps we can take in pursuit of this goal?

While almost all (92%) pollution-related deaths occur in low- and middle-income countries, the greatest impacts occur in countries that are currently undergoing rapid development and industrialisation […] Despite this, the authors argue that pollution is not the inevitable consequence of economic development, and applying similar legislation and regulation from high-income countries to low- and middle-income countries could help to improve and protect health as countries develop.

Indeed, we are at a point where global action needs to happen now. I hear many people argue that as US residents who live in a high-income country, we should not ask developing countries to cap their pollution (and carbon emissions) because that would deprive poorer people and countries of the same economic opportunities we have had. This argument is a moral one that fails to consider the outcome if only developed nations cooperate (though to be sure some curb in pollution is better than none). I’m glad to see these authors challenge this common sentiment (popular among some self-proclaimed progressives) and argue that there is a solution to the challenge of sustainable development.

On the other hand, issues of inequality and the vulnerability and health disparities that come with it certainly need to be considered.

An infographic from The Lancet states, “Pollution disproportionately kills the poor and the vulnerable.” The EPA and WHO have both created interactive maps. The EPA mapping tool (https://www.epa.gov/ejscreen) is part of an environmental justice and equity initiative. The tool allows anyone (it’s open access) to view side by side maps of social factors (e.g. income) and environmental hazards (e.g. air pollution). WHO has a statement on health equity (http://www.who.int/mediacentre/factsheets/fs292/en/):

Without a substantial change in policy, the total number of people relying on solid fuels will remain largely unchanged by 2030 (World Bank, 2010). The use of polluting fuels also poses a major burden on sustainable development.
· Fuel gathering consumes considerable time for women and children, limiting other productive activities (e.g. income generation) and taking children away from school. In less secure environments, women and children are at risk of injury and violence during fuel gathering.
· Black carbon (sooty particles) and methane emitted by inefficient stove combustion are powerful climate change pollutants.
· The lack of access to electricity for at least 1.2 billion people (many of whom then use kerosene lamps for lighting) exposes households to very high levels of fine particulate matter, as well introduces other health risks, e.g. burns, injuries and poisonings from fuel ingestion, constraining other opportunities for health and development, e.g. studying or engaging in small crafts and trades, which require adequate lighting.

To start, here are a few proposals to address these urgent policy needs:
· Scale up open access mapping tools to monitor air pollution for local, regional, and country levels that can be compared with social factors like income, transportation, employment rates etc.
· Strengthen regional and local coalitions and partnerships, mobilizing around improving health and supporting economic development
· Prioritize policy interventions for areas most affected by pollution and with the fewest resources
· Recognize that often those experiencing the worst air quality have the fewest financial resources and least mobility, and consider conditional cash transfers (CCT) as a policy intervention that provides a financial reward to city governments or local coalitions that need support to reduce pollution
· Measure the effectiveness of such policies and replicate in more areas

A CCT scheme could work with funding from international organizations (WHO, UNEP), research grants, and public-private partnerships (matching by foundations that have an environmental justice or public health mission statements). The conditions should primarily incentivize sustainable industrial development. But other considerations should include transportation, agriculture, wood-burning fireplaces and cook stoves burning biomass, and stemming the tide of unnecessary wildfires.

A recent study published in The New England Journal of Medicine, and reported on by the LA Times, surveyed Medicare patients (over 65 years of age) and found that, “men, blacks, Asians, Latinos and lower-income seniors all faced higher risks of premature death from fine particulate matter. Black seniors were three times as likely as seniors overall to die prematurely.”

In the midst of never-ending political turmoil, it’s difficult to see how this transition can be made. I think CCTs are one promising avenue, but we should also be working on regional and local-level collaborations to reduce pollution and focus primarily on incentivizing sustainable development through multiple streams. The authors of the Lancet report indicate that there have been some effective policy “wins” in middle- and high-income countries. We need to keep the momentum going and solicit workable solutions from low-income countries.

With the effects of climate change, we know there will be more fires. We simply have to enact policies to protect everyone, especially those with fewer resources, now.